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Island Commuter No More, Dr. Monto Is on the Move

For the past 10 years, Dr. Raymond (Rocco) Monto’s morning commute has been out of the ordinary.

Three times a week the orthopedic surgeon, one of just two on Martha’s Vineyard and the only one on Nantucket, drops off youngest son Rocco at school while daughter Siena boards a bus to Nantucket Elementary (older sons Alex and Nick are at Cape Cod Academy and the University of Connecticut, respectively).

Dr. Monto then boards a Cape Air plane and takes off for an island-to-island flight, heading to Martha’s Vineyard. Often he’s the only passenger.

But come May 31, Dr. Monto’s commute will lessen considerably in mileage, as he relocates full-time to Nantucket. The move was formally announced by his office last week, and comes in response to a decision by the Nantucket Cottage Hospital, which acquired Dr. Monto’s private practice five years ago.

“What’s happened in the five years since then is that the Nantucket hospital has been . . . underwriting this whole practice here on Martha’s Vineyard, and that’s not really a sustainable model [for them],” Dr. Monto said in an interview on Wednesday.

The Vineyard orthopedic practice was the first of its kind to be established here. Dr. Monto first washed ashore in 1996 from Philadelphia, where he began his medical career out of residency. A New York University medical school graduate, Duke resident and fellow at the Steadman-Hawkins Sports Medicin Clinic in Vail, he realized early on that working in a large hospital was not for him.

“I couldn’t give the care I wanted to, so that led to me coming here,” he said. An emergency room doctor at the Vineyard hospital had let him know the Island was searching for an orthopedic surgeon, and Dr. Monto applied for the job. At the time, he didn’t know where the Vineyard was.

“There wasn’t any established orthopedics on the Island,” he said. “There had been visiting surgeons, and they had done a great job, but there are limitations [to that].”

Any Island resident, physician or patient, knows there are built-in difficulties to providing and receiving medical care in an isolated area. For patients, there is often the matter of supply and demand: many patients, few doctors. For physicians, there is the matter of support — a stark change for doctors used to walking down the hall and finding assistance — and of privacy.

“You’re in a community with people you care about . . . if you’re uncomfortable taking care of people you know [outside of work], you can’t work here,” Dr. Monto said. “You’re involved all day. It’s the same on Nantucket.”

Nantucket had also been experiencing the visiting-surgeon dilemma for some time, and in 2004, the hospital began to send patients to Dr. Monto’s practice on the Vineyard. As with the Vineyard practice in its early days, there was no shortage of patients.

“It started out as a trickle and became a stampede, to the point where it was getting expensive and not practical or safe for all of these patients to be coming over from Nantucket,” Dr. Monto said. He opened a practice across the Sound, and began the morning commute. After five years, the Nantucket hospital brought the practice under its umbrella, a boon for its patients, Dr. Monto and his employees.

“We were faced with the reality of trying to run a [private] practice in Massachusetts, which is extremely challenging,” he said, describing the job as “all of the challenges of being a surgeon, plus all the challenges of running a small business.” Wife Jennifer is the office manager for the Island practices. “Without her, running one practice, let alone two, wouldn’t happen,” Dr. Monto said.

Dr. Monto arrived at his specialty of choice because of his own sports background as an All-American collegiate soccer goalie who dabbled in professional leagues. His soccer involvement continues today both locally (last year, his team in the men’s recreational program on the Vineyard won the league) and nationally (since 1993, he has worked for the American national soccer teams).

“I had been hurt enough times [and] thought my surgeons were not that good, so I thought I could do better,” he said.

The field of orthopedics has seen immense changes since its inception, and especially over the past 20 years. “Everything I do today is different than when I started,” Dr. Monto said. Advances in arthroscopic surgery, soft tissue treatment, and imaging stand out among the myriad small changes. Arthroscopic work has become “the bedrock of what we do,” he said.

“That’s a unique thing here on the Island; no one believes me,” Dr. Monto said.

Fifth metatarsal treatments may decrease with the move to Nantucket, but Dr. Monto stressed that Vineyard patients would always be welcome across the Sound.

“We’re not closing the practice, it’s just this branch of it,” he said. “That door’s always open.”

Comments (5)

Rick Lambos, Edgartown

From November of 1996 to September of 2011 I have had the pleasure of having 3 knee arthroscopes, one rotator cuff repair, 2 PRP procedures on a second rotator cuff injury, that worked well enough to avoid a surgical procedure, all by Dr Monto. I also had the pleasure of working with him in the Vineyard OR when he first came to the island. He is a top notch orthopedic surgeon, with a tell it like it is approach. He will be missed on the island but I myself will not hesitate to hop on a boat/plane to see him on Nantucket if the need arises. Good luck Rocco and thanks for all your years of service to the Vineyard.

My mother broke her arm in the summer of 2010. Luckily, Dr. Monto treated her and eventually performed surgery. My mother was 86 at the time and had Alzheimer's. I will never forget the kindness and compassion shown to her by Doctor Monto. The closing of his practice is such a loss for the island. Thank you Dr. Monto!

Dr. Monto has a been a tremendous resource for the Vineyard. He has steadfastly repaired and taken care of the residents, been a charitable supporter of youth sports, as well as been an active participant in our community. Caveat Emptor: Rocco is a personal friend (and a teammate). He has cared for and supported our rather unique community. There is no replacing a skilled medical practitioner with a real passion for his science as well as a true cultivated understanding of the the community, its needs, its collective attitudes and lifestyle. Aside from his value as a person deeply and positively involved in our community, strictly as a physician he will be nearly impossible to replace. I hope that the island hospitals can find a way to continue to share this precious resource in the future. I would personally like to thank him for all the support, care and attention he has paid to the island's soccer players over the years. Especially as a MV youth soccer and the MVRHS Head Coach I want to publicly thank him for the personal and professional care he has provided to literally hundreds of island kids. Our loss is now Nantucket's gain. I hope and would urge people capable of reviewing the process which will limit or prevent access to one of our best doctors to reconsider whatever issues that predicated this move at the soonest possible opportunity. As a very active working and sporting community our collective health and quality of life has not been well served in losing Dr. Monto's practice. For the moment, thank you again and best of luck Rocco, break a leg (or 5th metatarsal)!
Note: Monto Orthopedic's Soccer Team (Monto FC) WILL defend it's commanding hold of the VFA summer league championship in 2013.